ONE OF GOV. Charlie Baker’s biggest initiatives that he attempted, but failed, to pass would have reoriented health care spending so a greater portion of health care spending went toward primary and behavioral health care, rather than specialty care.
Legislation that Baker sponsored would have required health care providers and payers to increase spending on primary and behavioral health care by 30 percent over three years compared to 2019 levels, while still staying under a health care benchmark that sets targets for total health care spending.
The Legislature did not take up Baker’s bill, and the governor is not running for reelection, so his proposal is likely dead. But a report by the state’s Center for Health Information and Analysis, released Tuesday, puts concrete numbers on exactly how much Massachusetts has been spending on primary and behavioral health care – key figures should proposals similar to Baker’s emerge in the future. The report will also be important as the Legislature monitors implementation of a new law aimed at improving access to mental health care, which charges CHIA with monitoring state spending on mental health services.
“When CHIA began this data collection, comprehensive information was limited on the level of investment in primary care and behavioral health services in the Commonwealth and this report greatly expands our understanding of spending on these important areas,” said Ray Campbell, CHIA’s executive director. “The ability to measure both primary care and behavioral health expenditures sets Massachusetts apart nationally and creates a factual foundation to support public policy discourse.”
In raw numbers, spending on primary care totaled $2.1 billion in 2019, dropping to $1.9 billion in 2020. The decline is due to the onset of the COVID-19 pandemic, which led to mass cancellations of routine and non-urgent health care visits as the state went into lockdown in March 2020. The data show a large drop in office visits, particularly preventive care, between 2019 and 2020.
Spending on behavioral health care was a comparable $2.1 billion in 2019, but increased to $2.2 billion in 2020. That increase represents a significant jump in mental health care in a year when behavioral health spending jumped by 9.1 percent even though spending on all other services declined by 4.2 percent.
The report attributes the higher spending on behavioral health care to increased need, due to the effects of the pandemic, and to increased use of telehealth for mental health care. It proved much easier to expand the use of telehealth for mental health care than physical health care. Spending on outpatient behavioral health care jumped by 17.1 percent for commercially insured patients between 2019 and 2020. For Medicaid patients, who are low-income, the biggest jump was in inpatient care, which rose by 18.3 percent between 2019 and 2020.
In 2020, the report finds that primary and behavioral health care combined made up 16.2 percent of total health care spending.
The report also breaks spending down by insurance type and found that Medicaid spent a far higher percent of its expenditures on behavioral health care, compared to commercial insurance or Medicare. This likely reflects baseline difference between the populations – with Medicaid reporting more patients with behavioral health diagnoses – and generous Medicaid coverage, under which more mental health services are covered without significant copays compared to commercial insurance.
Asked why release the report now, when Baker first made his proposal in 2019, Erin Bonney, director of health informatics and reporting at CHIA, said the agency started collecting data in the fall of 2019, but the organization wanted to complete two years of data collection and dig into the quality of the data before publishing, to make sure the information was accurate.